
<div class="form-group">
<div class ="container">
<form class="form-horizontal" role="form" action="<?php echo site_url('usman/input_form');?>" method="post">
<label>Nama</label>
<input required class="form-control" id="nama" type="text" name="nama" maxlength="50" value=""></br>
<label>Username</label>
<input required class="form-control" id="nama" type="text" name="username" maxlength="50" value=""></br>
<label>Password</label>
<input required class="form-control" id="waktu" type="password" name="password" maxlength="50" value=""></br>
<label>Role </label>
<select required name="role">
<option value="1">Safety Representative</option>
<option value="2">Pengawas</option>
<option value="3">Sekretaris</option>
<option value="4">Manajer</option>
<option value="5">Administrator</option>
</select>
</br>
<label>Bagian </label>
<input required class="form-control" id="lokasi" type="text" name="bagian" maxlength="50" value=""></br>
<label>Departemen </label>
<input required class="form-control" id="lokasi" type="text" name="departemen" maxlength="50" value=""></br>
<label>NIK </label>
<input required class="form-control" id="lokasi" type="text" name="nik" maxlength="50" value=""></br>
<label>Jabatan </label>
<input required class="form-control" id="lokasi" type="text" name="jabatan" maxlength="50" value=""></br></br>
<input required name="submit" type="submit" class="btn btn-primary" value="Kirim"/>
</div>

		
		</form>
		</div></body></html>